ASAPS 2009: breast implants & biofilms

Tuesday, May 12, 2009

One of the big topics of discussion at ASAPS this year was biofilms. Biofilms are a type of bacterial contamination that loves to form on solid, implanted devices like man-made heart valves, contact lenses, orthopedic implants, and yes...breast implants. There is a growing body of research that suggests that these biofilms are linked to the #1 unsolved problem of breast implants - capsular contracture.

Implant-associated biofilms don't cause fevers, redness or typical infection issues. They are difficult to detect without specialized testing. They are resistant to standard antibiotic treatment, and are virtually impossible to clean off from the implanted device. But when the sepcialized tests are done, there is a much higher incidence of these bacterial biofilms in women who have capsular contracture, compared to the tissue around soft, "normal" breast implants. Most commonly, the bacteria involved is Staph. epidermidis - the common bacteria that lives on our skin, and is also found inside the normal breast gland.

So, what does this mean? Well, taking this concept to its logical conclusion would suggest:

1. At the time of the initial surgery, take steps to reduce the chance of implant contamination. This can be done through technical measures such as using an antibiotic irrigation (or betadine) to rinse the implant and the implant pocket. Consider using the infra-mammary incision (more direct) rather than the peri-areolar incision (more contact with breast tissue).

2. At the time of a capsulectomy operation, consider using a brand-new implant (no biofilm), rather than re-using the old implant. Perform total capsulectomy (removing all of the capsule) rather than capsulotomy (cutting the capsule, but leaving it in place.)

3. After surgery, treat the breast implant just like a artificial heart valve, and take antibiotics whenever you have a procedure that might cause bacteria in the bloodstream, like dental cleanings, endoscopy, or minor surgery.

4. Researchers are investigating anti-bacterial coatings for implants, and other longer-lasting antibacterial delivery systems. One promising method involves a compound called Ageliferin, which disperses biofilm, and re-sensitizes the bacteria to antibiotics.

So far, most of the research is lab stuff. There haven't yet been large clinical studies giving us the answers that we need to make day-to-day decisions. But, it's hopeful that we're getting closer to finding an answer for the problem of capsular contracture.

Thomas Fiala, MD5/12/2009

Comments:

Hello Dr. Fiala,
Interesting brief on biofilms. I am a researcher that works a lot on biofilms and their prevention with clinicians (I am a clinician too). Interestingly enough, a couple of years ago we approached several implant companies regarding a biodegradable gel with outstanding multi-species biofilm inhibiting abilities. The approach would be to either ship the implants coated or coat them by hand in the Sx suite. There was also the added benefit of "lubricating" the implants for insertion. We also knew from our testing that (at least subQ) the material had no foreign body reaction (i.e. collagen wall off).
Regrettably, we just did not get much interest. The solution is very cheap too. Alas we moved on to other disciplines like ENT, Urology and Wound Care (chronic infections).
Thanks for your article. Good reading...
Dr. J